Provider Demographics
NPI:1376160804
Name:JIA, TAIPING
Entity Type:Individual
Prefix:
First Name:TAIPING
Middle Name:
Last Name:JIA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5677 BONITA RD
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-3217
Mailing Address - Country:US
Mailing Address - Phone:503-475-9657
Mailing Address - Fax:
Practice Address - Street 1:7100 SW FIR LOOP # 205
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-8022
Practice Address - Country:US
Practice Address - Phone:503-475-9657
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-01
Last Update Date:2020-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC00654171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR8236501OtherDRIVER LICENSE